Healthcare practitioners are expected to speak up about patient safety concerns to help intercept errors and avoid adverse patient outcomes. By ‘speaking up,’ we mean raising concerns for the benefit of patient safety and quality of care upon recognizing or becoming aware of a risk or a potential risk. Such risks may include concerns about the safety of an order or treatment modality, a possible missed diagnosis, questionable clinical judgment, rule breaking, dangerous shortcuts, incompetence, and disrespect. Healthcare practitioners, especially frontline staff, are well positioned to observe unsafe conditions and bring them to the attention of those who can remediate them.
Speaking up is a behavioral choice under every healthcare practitioners’ control, but this is quite different than simply voicing a suggestion. A practitioner who bravely expresses a patient safety concern may cause the recipient to become defensive and set themselves up for negative repercussions. In deciding whether to speak up, the practitioner typically engages in a deliberate decision process whereby he or she considers both the positive and negative consequences, as well as the anticipated effectiveness and safety of voicing the concern. It is a balancing act of trying to be proactive and constructive while at the same time considering the possible personal costs of speaking up. As a result, all too often, practitioners will hesitate to voice their concerns, choosing the “safe” response of silence.On the other hand, they may speak up and be ignored or easily convinced that their concerns are unfounded. Silence and dismissed concerns are especially dangerous types of communication breakdowns.
ISMP is not discounting the fact that many complex factors influence whether healthcare practitioners speak up about patient safety concerns. We also do not discount the extraordinary courage it may take for many to step up to these conversations. However, tolerance of risk that goes unchallenged is a serious patient safety concern, and to combat that, all who interact with patients must become an observant questioner and raise their index of suspicion of errors. Healthcare practitioners need to ensure that patient safety concerns are not only raised but also properly investigated and addressed. You can be sure that those involved in serious and fatal errors wish that they had taken the opportunity to do just that.
Posted on October 10th, 2019
Original article: https://www.ismp.org/resources/speaking-about-patient-safety-requires-observant-questioner-and-high-index-suspicion